Healthcare Provider Details

I. General information

NPI: 1538454962
Provider Name (Legal Business Name): LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MADISON AVE STE 1060
NEW YORK NY
10165-1060
US

IV. Provider business mailing address

ONE GRAND CENTRAL PLACE 305 MADISON AVENUE, SUITE 1060
NEW YORK NY
10165
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-1336
  • Fax:
Mailing address:
  • Phone: 917-470-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: LUBA NAKHUTINA
Title or Position: OWNER/PRESIDENT
Credential: PH.D.
Phone: 917-470-1336